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Background: International guidelines recommend ivosidenib followed by modified FOLFOX (mFOLFOX) for advanced intrahepatic cholangiocarcinoma (ICC) with isocitrate dehydrogenase 1 (IDH1) mutations. Taiwan National Health Insurance covers only fluorouracil/leucovorin (5-FU/LV) chemotherapy for this ICC group, and there has been no prior economic evaluation of ivosidenib. Therefore, we aimed to assess ivosidenib's cost-effectiveness in previously treated, advanced ICC-presenting IDH1 mutations compared with mFOLFOX or 5-FU/LV. Methods: A 3-state partitioned survival model was employed to assess ivosidenib's cost-effectiveness over a 10-year horizon with a 3% discount rate, setting the willingness-to-pay threshold at 3 times the 2022 GDP per capita. Efficacy data for Ivosidenib, mFOLFOX, and 5-FU/LV were sourced from the ClarIDHy, ABC06, and NIFTY trials, respectively. Ivosidenib's cost was assumed to be NT$10,402/500 mg. Primary outcomes included incremental cost-effectiveness ratios (ICERs) and net monetary benefit. Deterministic sensitivity analyses (DSA) and probabilistic sensitivity analyses (PSA) were employed to evaluate uncertainty and explore price reduction scenarios. Results: Ivosidenib exhibited ICERs of NT$6,268,528 and NT$5,670,555 compared with mFOLFOX and 5-FU/LV, respectively, both exceeding the established threshold. PSA revealed that ivosidenib was unlikely to be cost-effective, except when it was reduced to NT$4,161 and NT$5,201/500 mg when compared with mFOLFOX and 5-FU/LV, respectively. DSA underscored the significant influence of ivosidenib's cost and utility values on estimate uncertainty. Conclusions: At NT$10,402/500 mg, ivosidenib was not cost-effective for IDH1-mutant ICC patients compared with mFOLFOX or 5-FU/LV, indicating that a 50–60% price reduction is necessary for ivosidenib to be cost-effective in this patient group. [ABSTRACT FROM AUTHOR]

• Gluconacetobacter xylinus uses molasses as a carbon source for cellulose production. • Molasses derived cellulose was highly porous and stable. • C. sorokiniana AK-1 was entrapped in cellulose by co-culture with G. xylinus. • Cellulose entrapped microalgae were effective in the treatment of 50% wastewater. • COD, TN and TP removal efficiency were 50.93, 82.56 and 81.48%, respectively. Taiwan's livestock industry has played an important role in agricultural development in the past decades. In addition to bringing prosperity and huge benefits to the countryside, it also generates wastewaters that cause eutrophication in water bodies. Bioremediation of wastewaters by immobilized microalgae has proven to be beneficial for high-strength wastewaters. In situ immobilization of Chlorella sorokiniana AK-1 in bacterial cellulose (BC) was performed by co-culture with BC producing Gluconacetobacter xylinus using molasses as a carbon source. BC immobilized AK-1 was further applied for the treatment of dairy manure wastewater. Molasses at 5 g/L were utilized for high yield BC production by G. xylinus. The alkaline nature of the cultivation medium in the presence of molasses resulted in highly porous cellulose that facilitated microalgal attachment and growth. Bacterial HS medium and the microalgal BG-11 medium, mixed in a ratio of 1:1 resulted in effective granule formation with optimal microalgal density. The B50 granules obtained were applied for 50% dairy manure wastewater. The removal efficiency for total carbon, nitrogen and phosphorus with B50 microalgal granules were 50.93, 82.56 and 81.48%, respectively. Thus, microalgae immobilized on bacterial cellulose are effective for the bioremediation of high-strength wastewaters. [ABSTRACT FROM AUTHOR]

Abstract: The Copenhagen Accord in 2009 initiated new opportunities for international cooperation in reducing greenhouse gas (GHG) emissions. The purpose of this study was to review Taiwan''s current climate policy and, in response to the Copenhagen Accord, to deliberate this policy in the light of new strategic thinking. The study proposes a two-stage approach with a dividing line in 2020. In the first stage, from now until 2020, strategy should be based on cost constraints, with a suggested reduction cost below $60/t-CO2, and implementation of domestic GHG emissions trading scheme and reduction strategies. In the second stage, from 2020 and beyond, action by Taiwan should, accord with international cooperative actions to link its domestic emissions trading scheme with the international carbon market. [Copyright &y& Elsevier]

Abstract: It is the opinion of this study that more than 10 years of the United Nations Framework Convention on Climate Change (UNFCCC) negotiations have been wasted on determining the greenhouse gas (GHG) emission targets. This study discussed two approaches of GHG reduction targets: top-down approach and bottom-up. This study criticized the top-down approach for reduction target determination has created a new problem for emission reduction efforts. Using Taiwan as a case study, this study adopted the GACMO model to decompose the energy policy and analyzed the cost effectiveness of various reduction strategies. Reviewing the emission reduction measures based on the bottom-up approach is the proper way to address GHG emission reductions. Thus, the countries should refocus on implementation of reduction strategies in the spirit of the UNFCCC. Finally, this study believes that if the reduction cost curves of each nation can be made, the Bali roadmap reached through the 2007 UNFCCC COP13/MOP3 in Bali, Indonesia, can be more defined and practical. [Copyright &y& Elsevier]

Background: While Reddy proposed the H2FPEF diagnostic algorithm to aid in diagnosing heart failure with preserved ejection fraction (HFpEF), certain parameters like age and obesity are not suitable for Asian population, especially given the increasing incidence of HFpEF in younger individuals. Therefore, this study aimed to develop an easy-to-use nomogram with non-invasive indices that can be used in outpatient clinics in Taiwan to quickly estimate the probability of HFpEF and help decide whether further invasive cardiopulmonary exercise test (CPET) is needed., Methods: Outpatients with unexplained dyspnea and fatigue were recruited divided into HFpEF (n = 64) and non-HFpEF (n = 34) groups based on invasive CPET and echocardiography. Multivariate logistic regression analyses identified independent noninvasive variables for developing an HFpEF nomogram. The nomogram's performance was assessed and validated using the concordance index (C-index), area under the curve (AUC), calibration curves, and decision curve analysis., Results: Multivariate logistic regression analyses identified five independent noninvasive variables for developing an HFpEF nomogram, including dyslipidemia (OR = 5.264, p = 0.010), diabetes (OR = 3.929, p = 0.050), left atrial area (OR = 1.130, p = 0.046), hemoglobin <13 g/dL (OR = 5.372, p = 0.010), and NT-proBNP ≥245 pg/mL (OR = 5.108, p = 0.027). The nomogram showed good discriminatory ability (C-index = 0.842) and calibration performance (p = 0.873) and high net benefit (0.1-0.95). Notably, the HFpEF nomogram showed better diagnostic accuracy than the H 2 FPEF score model in predicting Taiwanese HFpEF patients (AUC: 0.873 vs. 0.608, p = 0.0006)., Conclusion: The noninvasive HFpEF nomogram provides a preliminary estimation of the probability of HFpEF in Taiwanese outpatients with unexplained dyspnea and fatigue, which may help the decision-making on further invasive CPET., Competing Interests: Declaration of Competing interest All authors declare that there is no conflict of interest., (Copyright © 2024 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.)

Background: AHEAD (A: atrial fibrillation; H: hemoglobin; E: elderly; A: abnormal renal parameters; D: diabetes mellitus) score has been related to clinical outcomes of acute heart failure. However, the prognostic value of the AHEAD score in acute heart failure patients with either reduced or preserved left ventricular ejection fraction (HFrEF and HFpEF) remain to be elucidated., Methods and Results: The study population consisted of 2143 patients (age 77±12 years, 68% men, 38% HFrEF) hospitalized primarily for acute heart failure with a median follow-up of 23.75 months. The performance of the AHEAD score (atrial fibrillation, hemoglobin <13 mg/dL for men and 12 mg/dL for women, age >70 years, creatinine >130 μmol/L, and diabetes mellitus) was evaluated by Cox's regression analysis for predicting cardiovascular and all-cause mortality. The mean AHEAD scores were 2.7±1.2 in the total study population, 2.6±1.3 in the HFrEF group, and 2.7±1.1 in the HFpEF group. After accounting for sex, sodium, uric acid, and medications, the AHEAD score remained significantly associated with all-cause and cardiovascular mortality (hazard ratio and 95% CI: 1.49, 1.38-1.60 and 1.48, 1.33-1.64), respectively. The associations of AHEAD score with mortality remained significant in the subgroups of HFrEF (1.63, 1.47-1.82) and HFpEF (1.34, 1.22-1.48). Moreover, when we calculated a new AHEAD-U score by considering uric acid (>8.6 mg/dL) in addition to the AHEAD score, the net reclassification was improved by 19.7% and 20.1% for predicting all-cause and cardiovascular mortality, respectively., Conclusions: The AHEAD score was useful in predicting long-term mortality in the Asian acute heart failure cohort with either HFrEF or HFpEF. The new AHEAD-U score may further improve risk stratification., (© 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.)

Red cell distribution width (RCDW) has not been fully investigated for its prognostic impact in patients with acute heart failure (AHF) with or without the cardiorenal anemia syndrome (CRAS). A total of 978 patients (age 75 ± 14 years, 70% men, 43% with CRAS) hospitalized for AHF were enrolled. During a median follow-up duration of 31 months, 472 subjects (48%) died. The postdischarge mortality was positively associated with the increasing RCDW. After accounting for age, gender, co-morbidities, hemoglobin, renal function, sodium level, and N-terminal probrain natriuretic peptide, RCDW remained an independent predictor of mortality (hazard ratio [HR] and 95% CI for a 1% increase of RCDW: 1.09, 1.00 to 1.17, p = 0.04). In the subgroups of patients with or without CRAS, RCDW was an independent predictor of total mortality for both subgroups (HR 1.05, 95% CI 1.00 to 1.10 and HR 1.11, 95% CI 1.07 to 1.15, respectively). In conclusion, elevated RCDW was independently associated with mortality in patients hospitalized for AHF, with or without CRAS., (Copyright © 2016 Elsevier Inc. All rights reserved.)